Provider Demographics
NPI:1700050531
Name:HARRIS, ANN HOLMGREN (MSN, APRN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:HOLMGREN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17353 HAZEL ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456
Mailing Address - Country:US
Mailing Address - Phone:616-847-0173
Mailing Address - Fax:616-847-0173
Practice Address - Street 1:17353 HAZEL ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456
Practice Address - Country:US
Practice Address - Phone:616-847-0173
Practice Address - Fax:616-847-0173
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704085039364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology